A. Explanation and reassurance – Explanation
This woman has the baby-blues which is seen in around two-thirds of women. Whilst poor sleeping
can be a sign of depression it is to be expected with a new baby!
Post-partum mental health problems
Post-partum mental health problems range from the ‘baby-blues’ to puerperal psychosis
| ‘Baby-blues’ | Postnatal depression | Puerperal psychosis |
| Seen in around 60-70% of Women Typically seen 3-7 days following birth and is more common in primips Mothers are characteristically anxious, tearful and irritable |
Affects around 10% of women Most cases start within a month and typically peaks at 3 months Features are similar to depression seen in other circumstances |
Affects approximately 0.2% of women Onset usually within the first 2-3 weeks following birth Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations) |
| Reassurance and support, the health visitor has a key role |
As with the baby blues reassurance and support are important Cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine* may be used if symptoms are severe** – whilst they are secreted in breast milk it is not thought to be harmful to the infant |
Admission to hospital is usually required There is around a 20% risk of recurrence following future pregnancies |
*paroxetine is recommended by SIGN because of the low milk/plasma ratio
**fluoxetine is best avoided due to a long half-life
